Clinicalanalysis Of 54 Cases Of Heterotopic Pregnancy After In Intro Fertilization And Embryo Transfer

Objective: Through the analysis of the clinical data of heterotopic pregnancy(HP)after in vitro fertilization and embryo transfer(IVF-ET),the high risk factors,diagnosis and treatment methods were discussed to provide the basis for clinical diagnosis and treatment.Methods: Retrospective analysis of 54 patients diagnosed with HP after IVF-ET in the first affiliated hospital of guangxi medical university from July2012 to January 2019.The general situation,high-risk factors,clinical symptoms,ultrasound characteristics,treatment and pregnancy outcome were analyzed.All data were analyzed using SPSS 22.0 software.Results:(1)Among the 54 patients with HP,31 patients(57.4%)had suffered tubal surgery.There was no history of tubal surgery in 23 patients,among which 16 patients(69.6%)had a history of tubal obstruction or hydrops.(2)Among the 54 HP patients,43 patients(79.6%)had vaginal bleeding and/or abdominal pain,among which 7 patients had shock symptoms.There were 11 asymptomatic patients(20.4%),which were found by Transvaginal sonography(TVS).The ectopic pregnancy site of 46 patients(85.2%)were located in oviduct,most commonly in the ampullary region(30/46,65.2%).(3)Preliminarydiagnosis was obtained through TVS in all 54 HP patients.The gestational age of the first ultrasound diagnosis was 6.73±1.13 weeks.Among them,there were32 patients(59.3%)confirmed by the first ultrasound,whose gestational age were 6.11±0.56 weeks,and 22 patients(40.7%)had undiagnosed by the first ultrasound,whose gestational age were 5.80±0.70 weeks,There was no significant difference between the two groups(P > 0.05).(4)Intrauterine pregnancy was retained in 46 patients.44 patients(95.7%)were treated with surgery,including 39 cases of laparoscopic surgery and 5 cases of open surgery.There was no significant difference in the survival rate between the two surgical methods(P > 0.05).Different ectopic pregnancy sites and different surgical methods had no significant effect on the pregnancy outcome(P >0.05).Interventional therapy was performed in 2 cases.The overall survival rate of IUP after treatment was 71.7%(33/46).(5)For the patient without shock,the gestational age of the abortion group was less than that of the non-abortion group(P < 0.05).Conclusion:(1)Abnormal structure and function of fallopian tubes,tubal surgery history are high risk factors for HP,and ART significantly increases the incidence of HP.(2)TVS is the most important means for diagnosing HP,but there is still a high probability of missed diagnosis.TVS examination at week6-8 of pregnancy is recommended.Multiple ultrasonographic examinations are required to confirm the diagnosis for patients with high-risk factors.(3)Surgical treatment is the most important treatment for HP.After the treatment of HP,the pregnancy outcome was better.Under the condition of stable vital signs,it is suggested that the treatment at week 6-8 of pregnancy may increase the probability of live birth.